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Welcome Parents: 

Welcome Parents: 

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Published by api-20731342

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Published by: api-20731342 on Dec 22, 2009
Copyright:Attribution Non-commercial


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elcome Parents:
We are so glad to have your children be part of our new program. We arelooking forward to watching your children succeed and make new friends inour innovative socialization program.
e are forming a partnership with you for the benefit of your child. We willalways be available to answer your questions or concerns.
Best Regards,
Piera & Chris
Piera Bacolo (718) 605-6930Chris Caruso (718) 874-6109
ame of child: _________________________________________________ 
Date of birth: _________________ 
School child attends: _____________________________________________________
Parent’s name: _________________________________________________ 
ddress: ______________________________________________________ 
Phone Numbers
Home: _______________________________ 
ork: _______________________________ 
Cell: _______________________________ 
Email address: ________________________________________ 
How did you hear about us? _____________________________________ 
Please list any allergies child may have:
Information Sheet
When was he/she diagnosed and what is the diagnosis?
Is he/she on any medication?
What are his/her verbal capabilities? _______________________________________ How well does he/she follow verbal prompts/instructions? ___________________________________  ____________________________________________________________________________________ 
1. _________________________________________________  2. ________________________________________________  3. ________________________________________________  
Information about your child:
Please list any likes or dislikes your child may have:
In the box below, please tell us a little about your child:

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